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ASTRA Guaranteed Income
Application Form
for Individual Contracts
ASTRA Segregated Funds
For the following plans:
SSQ Retirement Savings Plan – SSQ RSP
SSQ Locked-In Retirement Account – SSQ LIRA
SSQ Non-Registered Investment Plan – SSQ INV
SSQ Retirement Income Fund – SSQ RIF
SSQ Life Income Fund – SSQ LIF
SSQ Prescribed Registered Retirement Income Fund – SSQ PRRIF (Saskatchewan only)
SSQ Locked-In Retirement Income Fund – SSQ LRIF (Manitoba, Newfoundland and Labrador only)
The individual variable insurance contract is issued by SSQ, Life Insurance Company Inc.
ASTRA Fund Names and Code Numbers
No-load No-load
Back-load Front-load
ASTRA Fund Names Name Abbr. Option Option
Option Option2
(Mode A)1 (Mode B)1
INCOME FUNDS
Money Market (McLean Budden) MON MAR N/A G136 G236 N/A
Treasury (Optimum Asset Management Inc.) TREAS N/A G1604 G2604 N/A
BALANCED FUNDS
PRO SSQ Conservative Fundamental GIF Portfolio PRO CON G0612 G1612 G2612 G3612
PRO SSQ Balanced Fundamental GIF Portfolio PRO BAL G0613 G1613 G2613 G3613
PRO SSQ Growth Fundamental GIF Portfolio PRO GR G0614 G1614 G2614 G3614
PRO SSQ Aggressive Fundamental GIF Portfolio PRO AGG G0615 G1615 G2615 G3615
Please refer to the Information Folder for detailed information about all available funds.
1
No fees are charged to the client for no-load sales charge options (Modes A and B), whether for purchases or redemptions. However, fees are charged to the Agency and the Advisor for
Mode B when redemptions are made during a certain period. Please see your Remuneration Schedule for all details.
2
For the front-load option, please indicate the percentage (or amount) in Section 10 of the Application Form.
ASTRA Guaranteed Income
New Contract
Modification/Addition to Contract Contract No.: 10 -
If requesting a modification / addition to an existing contract, be sure to indicate the Contract Number and
complete only the sections requiring changes. Your contract information in other sections will remain unchanged. Also,
please note that it is not possible to make changes to Sections 1, 4 and 5 and therefore SSQ will not take into account
Please print clearly. any information entered in those sections.
Section 1: Type of Contract / Plan In the absence of any choice, the contract will be designated a “client” type contract by default.
Client (Choose one plan only. Refer to the “General Information and Instructions for Completing Application Form” section for more details about the plans available.)
SSQ RSP SSQ Spousal RSP 1 SSQ INV (Non-registered) SSQ RIF 2 SSQ Spousal RIF 1, 2
SSQ LIRA 3 SSQ LIF 2, 3 SSQ PRRIF (Saskatchewan) 2 SSQ LRIF (Manitoba and Newfoundland and Labrador) 2, 3
1
Complete Section 4. 2
Complete Section 9.
3
Indicate pension legislation applicable to plan and whether it is a restricted plan:
Nominee / Dealer
SSQ INV External Plan Specify plan:
Nominee / Intermediary
Section 2: Guarantee
The guarantee applicable to the ASTRA Guaranteed Income is described in the product Information Folder.
Section 3: Investor
The investor must be a resident of Canada. If the investor is a corporation or another entity, include a company resolution, and complete Section 5 and the FRA1235
form.
Last Name First Name Social Insurance Number
Y Y Y Y M M D D
Address (No.) Street Apt. Birth Date
Town / City Province Postal Code
Gender: Female Male
Telephone (home) Telephone (work) E-mail Language: French English
Profession or activity carried out by the company
For INV, RIF, LIF, PRRIF and LRIF plans only
Document used to identify Investor: Birth Certificate Passport Driver’s Licence Other
Document Number: Delivery Location:
For INV plans only
Is the investor, the co-investor or the trustee acting on behalf of a third party or is he or she a politically exposed foreign person (PEFP) or a close relative of a PEFP?
No Yes If yes, complete the FRA1234 form.
Section 4: Other Parties to the Contract
Payer (complete for a Spousal RSP or Spousal RIF)
Spouse (complete only if, under Section 9C, you wish minimum income payments for RIF, LIF, PRRIF or LRIF to be calculated based on spouse’s age)
Co-investor (available for INV Plan only) Sharing Ratio: Investor: % Co-investor: %
Legal Representative Tutor Curator Trustee (attach copy of the trustee act)
Last Name First Name Social Insurance Number
Y Y Y Y M M D D Gender: Female Male If address different from investor’s, please indicate it in Section 10.
Birth Date Please note that SSQ sends information related to contract to investor’s address.
For INV plans only
Document used to identify co-investor or trustee: Birth Certificate Passport Driver’s Licence Other
Document Number: Delivery Location:
FRA1292A (2009-05)
Reserved for SSQ use only SSQ FINANCIAL GROUP – CLIENT SERVICES:
10 - 1-888-391-9299
Contract No. INVESTOR COPY XXX000XXX
Section 5: Annuitant
For registered plans, the annuitant is the same person as the investor. For the INV plan, the annuitant may be a different person than the investor. The annuitant must
obligatorily be a physical person and must be a resident of Canada, as required under the law. In the absence of any instructions, the annuitant is the same person as the
investor.
Last Name First Name Social Insurance Number
Y Y Y Y M M D D Gender: Female Male If address is different from investor’s, please indicate it in Section 10.
Birth Date Please note that SSQ sends information related to contract to investor’s address.
Section 6: Benefit Upon Death of Annuitant Complete for “Client“ type contract only. If not enough space provided, please use Section 10.
In the event of the death of the annuitant, I hereby assign any death benefit payable under the terms of my contract to the beneficiary(ies) mentioned here below or, in the
absence of a beneficiary designation, to my estate, subject to applicable pension legislation. By default, beneficiary designation is revocable.
In Quebec, a married or civil union spouse beneficary designation automatically becomes irrevocable unless the corresponding revocable box is checked:
revocable.
Relationship to the Annuitant (or, in Quebec, Relationship to the Investor) Sharing
Last Name, First Name Common- Ratio
Spouse* Other (%)
law Spouse
* The married or civil-union spouse.
If a beneficiary designation is irrevocable, the consent of the beneficiary must be obtained for any future modification to the designation and for any withdrawal, in part or in
whole, of the amount in the contract. If a minor child is designated as an irrevocable beneficiary, the irrevocable status of this designation cannot be modified until such
time as the child becomes major and consents to change the beneficiary designation by signing the required form.
Section 7: Source of Monies
Cheque Automatic Periodic Transaction (APT)
(payable to SSQ, Life Insurance Company Inc.) Complete Section 9.
Not applicable for LIRA, RIF, LIF, PRRIF and LRIF plans. Subject to the product minimum.
$
Transfer from an internal SSQ plan Transfer from an external plan to SSQ
Complete and include the FRA1238 form. Attach the appropriate form.
Name of assignee:
$
Contract No.: 10 - $ $
Section 8: Lump-Sum Investment
If instructions are incomplete or amounts less than minimum permitted, then amounts will be invested in the ASTRA Money Market Fund. A separate application must be
completed for the ASTRA Guaranteed Income product. If in addition to an ASTRA Guaranteed Income product, you wish to invest in ASTRA Funds that are not available
for the ASTRA Guaranteed Income product or in SSQ Guaranteed Investments, you must complete a second contract application form. Income generated will be reinvested
in the same fund.
ASTRA FUNDS
$10,000 minimum per contract (excluding ASTRA Money Market and Treasury Funds)
Minimum $400 for ASTRA Money Market and Treasury Funds
Fund No.1 Electronic Order No.
Abbr. Name Amount ($ or %)
MANDATORY (mandatory if FundSERV)
Total:
1
The first number of the fund indicates the sales charge option. Make sure the fund number accurately matches the fund and the sales charge option selected. If no choice is made as to the
FRA1292A (2009-05)
first number of the fund, the no-load sales charge option (Mode A) is selected by default.
Reserved for SSQ use only SSQ FINANCIAL GROUP – CLIENT SERVICES:
1-888-391-9299
INVESTOR COPY XXX000XXX
Section 9: Automatic Periodic Transaction (APT)
This section must be completed for RIF, LIF, PRRIF and LRIF plans. Amounts will be invested only upon reception of full and complete instructions.
A • Type of transaction (select one only) D • APT Redemption or APT Transfer “from”
APT Purchase (complete sections B, E and F) ASTRA FUNDS Complete this section for unit redemptions
Not available for LIRA, RIF, LIF, PRRIF and LRIF plans.
Fund No. 1
Amount ($)
APT Redemption (complete sections B, D and F and if an RIF, LIF, PRRIF or Abbr. Name
MANDATORY ($100 minimum per fund)
LRIF plan, also section C)
Not available for RSP and LIRA plans.
APT Transfer (complete sections B, D and E)
B • Payment frequency (select one only)
Weekly Bi-weekly
Indicate date of first transaction: Y Y Y Y M M D D
Monthly Bi-monthly Quarterly Semi-annually Annually Total: $
Indicate date of first transaction. By default, the date will be the first day of the E • APT Purchase or APT Transfer “to”
month following reception of the application form.
Subject to the product minimum.
Date must fall between 1st and 20th of month: Y Y Y Y M M D D
ASTRA FUNDS Complete this section for unit purchases
C • Information related to payments
Fund No.1 Amount ($)
Gross amount of each payment: Abbr. Name
MANDATORY ($40 minimum per contribution)
Minimum (RIF, LIF, PRRIF or LRIF)
Maximum (LIF or LRIF)
Levelled payment over years (RIF or PRRIF)
Fixed payment of $
Guaranteed Withdrawal Amount - GWA
Lifetime Withdrawal Amount - LWA
Other Total: $
By default, the minimum income payments are calculated based on the age Income generated will be reinvested in the same fund.
of the investor. If legislation permits, you may request that the minimum income 1
The first number of the fund indicates the sales charge option. Make sure the fund number
payments be calculated based on the age of the spouse by checking the box below: accurately matches the fund and the sales charge option selected. If no choice is made
Calculate based on age of spouse, as specified in Section 4. as to the first number of the fund, the no-load sales charge option (Mode A) is selected
Attach copy of Birth Certificate. by default.
F • Information about Financial Institution and Authorization
MANDATORY: Attach a personalized cheque specimen marked “VOID.”
Financial institution Branch No. Account No. Account Holder Other Account Holder (if applicable)
I authorize and request SSQ, Life Insurance Company Inc. to withdraw from the account indicated here above the funds required for the APT as specified in Section E, and/or to deposit into the
account indicated here above the funds as specified in Section D, where applicable. I agree to reimburse SSQ, Life Insurance Company Inc. for any amount that may be charged by my financial
institution, in fees or penalty, for refused transactions (for example, for insufficient funds).
Y Y Y Y M M D D Y Y Y Y M M D D
Signature of Account Holder (mandatory) Date Signature of Other Account Holder (if applicable) Date
Section 10: Additional Instructions
Section 11: Dealer / Advisor
Dealer’s Name (Agency) Agency No. (SSQ) Financial Security Advisor’s Name Advisor No. (SSQ)
FundSERV Code (if applicable):
Reference Account No. (if applicable) Dealer Advisor
Additional Information for “Nominee / Intermediary” Type Contract (if applicable)
FundSERV Code (if applicable):
Intermediary’s Name Telephone Reference Account No. (if applicable) Intermediary
FRA1292A (2009-05)
Address (No.) Street Town / City Province Postal Code
Reserved for SSQ use only SSQ FINANCIAL GROUP – CLIENT SERVICES:
1-888-391-9299
INVESTOR COPY XXX000XXX
Section 12: Authorizations and Signatures
Financial Security Advisor’s Declaration investor wishes to make investments and I have explained the terms and conditions of the
(signature of advisor is mandatory) contract, Information Folder, plan and investment vehicles selected by the investor.
I accept the mandate that the investor has entrusted me with and I agree to act at all times in I hereby certify that I have explained the impacts of this transaction to my client.
accordance with the investor’s instructions and to execute all contractual obligations related
I understand that when total annual withdrawals exceed the GWA and/or LWA, the impact
to documents signed by the investor. If applicable, as required by law, after having carefully
on the Guaranteed Minimum Withdrawal Benefit may be significant. I certify that I have
examined the appropriate original and valid documents, I have verified the identity and birth
made sure not to exceed the annual maximums so that my client can take full advantage of
date of all signatories to this contract, investors or others as required, especially for non-
this benefit. However, should these maximums be exceeded, I certify that I have explained
registered plans, under the Proceeds of Crime (Money Laundering) and Terrorist Financing Act.
the impacts of a withdrawal request to my client.
I certify having given the investor a copy of this completed form, the Annuity Contract, the
related Information Folder and any of its amendments, where applicable, under which the
Y Y Y Y M M D D
Signature of Advisor (mandatory) Date
Investor’s Declaration (signature of investor is mandatory)
I acknowledge receiving, as an investor, a copy of this duly completed form, the Annuity In the event that existing or future investments are made under the back-load sales charge option,
Contract, the related Information Folder and any of its amendments, where applicable, I understand that redemption fees may be applicable at the time of redemption of these units.
under which I wish to make investments and I understand the general terms and conditions
In the case where there is a co-investor, I acknowledge that both my signature and my
of the investment vehicles I have selected. In the case of an SSQ RSP or SSQ LIRA, I
co-investor’s signature are required for all transactions, including any change or revocation
request that SSQ, Life Insurance Company Inc. issue a retirement savings contract and
regarding the benefit upon the annuitant’s death.
register it as a Registered Retirement Savings Plan and, where applicable, register it as a
Locked-in Retirement Account. In the case of an SSQ RIF, an SSQ LIF, an SSQ PRRIF or I authorize SSQ, Life Insurance Company Inc. to use the information provided in this
an SSQ LRIF I request that SSQ, Life Insurance Company Inc. issue a retirement income application form, including my SIN, for administrative purposes. I authorize SSQ, Life
contract and register it as a Registered Retirement Income Fund and, where applicable, Insurance Company Inc. to verify my identity,when required by law, using an independent
register it as a Life Income Fund. I acknowledge having read the terms and conditions and reliable piece of identification and/or any other means permissible under the law. I also
applicable to this contract and agree to them. I understand that following registration acknowledge having read the contract notice concerning records and personal information
of this contract, any payment made by SSQ, Life Insurance Company Inc. to me or to and have kept a copy of this duly signed application form.
my spouse, where applicable, and to my beneficiaries or estate, is subject to applicable
I acknowledge having read the present declaration and the general information on this
income tax legislation and regulations.
application form, having understood its terms and conditions and have had the opportunity
For all contract types, I name to act in the capacity of my mandatary the financial to seek advice.
security advisor, dealer or intermediary, depending on the case, and, in so doing therefore,
I understand that if total annual withdrawals exceed the GWA and/or LWA, the impact
to receive and transmit all contributions to SSQ, Life Insurance Company Inc., to carry
on the Guaranteed Minimum Withdrawal Benefit may be significant. I have made sure
out the purchase, redemption, transfer, partial or total withdrawal, contract termination,
not to exceed these annual maximums in order to take full advantage of this benefit.
transaction reconciliation, as well as any transaction I may require, in accordance with the
However, should these maximums be exceeded, I certify that I understand the impacts
specific instructions that only I shall give. I authorize SSQ, Life Insurance Company Inc.
of a withdrawal request.
as well as the financial security advisor and/or dealer and/or intermediary, to exchange
any information required for administrative purposes.
Signed at
Town / City Province
Y Y Y Y M M D D
Signature of Investor (mandatory) Date
Please print name in block letters.
Y Y Y Y M M D D
Other Signature (where applicable – see Section 4 and Section 6) Date
Please print name in block letters.
For LIFs, PRRIFs and LRIFs for the provinces of Nova Scotia, Ontario, Alberta, Saskatchewan, British Columbia, Manitoba and Newfoundland
and Labrador ONLY
Spousal authorization for registration in locked-in plans
Do you have a spouse as defined under the pension legislation applicable to the plan? Yes No
If yes, please provide the following information:
For the provinces of Alberta, Saskatchewan, British Columbia and Manitoba, it is not necessary for the spouse to sign this section. However, please attach the
appropriate form indicating the spousal authorization or surrender in accordance with the pension legislation applicable.
For the provinces of Nova Scotia, Ontario and Newfoundland and Labrador, the spouse as defined under the applicable pension legislation must sign below to
indicate authorization for registration in the locked-in plan.
Y Y Y Y M M D D
Signature of the Spouse Date
FRA1292A (2009-05)
Reserved for SSQ use only SSQ FINANCIAL GROUP – CLIENT SERVICES:
1-888-391-9299
INVESTOR COPY XXX000XXX
General Information and Instructions for Completing Application Form
Section 1: Type of Contract / Plan
Only one type of contract and one plan may be selected per contract application. By default, the contract shall be designated as a “client” type contract.
All Nominee contracts shall be opened as non-registered (INV) plans at SSQ, Life Insurance Company (SSQ).
Three types of contracts are available:
1) Client: Contract undertaken in the name of the investor. There may be more than one investor for the same contract, in which case the additional investors
act in the capacity of co-investors;
2) Nominee/Dealer: Contract undertaken by a dealer in an SSQ INV Plan for a person who invests in an external account held by the dealer or the dealer’s
trustee;
3) Nominee/Intermediary: Contract undertaken by an intermediary in an SSQ INV Plan for a person who invests in an external account held by the
intermediary.
SSQ offers a choice of registered retirement plans and also offers a non-registered investment plan. Only locked-in sums may be paid into an SSQ LIRA, SSQ LIF,
SSQ PRRIF or SSQ LRIF.
Following are the different plans available according to the applicable annuity legislation. The expression “pension legislation” refers to pension plan
legislation that is applicable in Canada. If you don’t know the applicable pension legislation, the administrator from whom the amounts originated will have this
information.
Plan Select box on the form Legislation to indicate on the form
Registered Retirement Savings Plan RRSP SSQ RSP or SSQ Spousal RSP N/A
Registered Retirement Income Fund RRIF SSQ RIF or SSQ Spousal RIF N/A
Locked-In Retirement Account LIRA SSQ LIRA Indicate the province concerned
Ontario Locked-In Retirement Account Ontario-LIRA SSQ LIRA Indicate “Ontario”
Locked-In Retirement Savings Plan LRSP SSQ LIRA Indicate the province concerned or “Federal”
Restricted Locked-in Savings Plans RLSP SSQ LIRA Indicate “Federal” and also mention “restricted”
Locked-In Retirement Income Fund LRIF SSQ LRIF Indicate the province concerned (Newfoundland & Labrador or Manitoba)
Life Income Fund LIF SSQ LIF Indicate the province concerned or “Federal”
Restricted Life Income Fund RLIF SSQ LIF Indicate “Federal” and also mention “restricted”
Prescribed Registered Retirement Income Fund PRRIF SSQ PRRIF N/A
Non-Registered Investment Plan Non-Registered SSQ INV N/A
Section 2: Guarantee
Please refer to the Information Folder for the ASTRA Guaranteed Income product for guarantee terms and conditions.
Section 3: Investor
The investor must always be present at the time of the contract application. In accordance with this contract, the investor, and the co-investor, where applicable,
is (are) the contractholder(s) of the contract, i.e. the person(s) entitled to a claim corresponding to the value of the investments held at SSQ. The investor is also
the annuity grantee, i.e. the person entitled to receive the annuity payments. For all of the registered pension plans offered by SSQ, that is the SSQ RSP, SSQ LIRA,
SSQ RIF, SSQ LIF, SSQ PRRIF and SSQ LRIF, only a “physical person” (individual) may apply and the annuitant must be the same person as the investor and the
annuity grantee. Canada Revenue requires the SIN for tax purposes.
In the case where the investor is a corporation or another entity, only a non-registered plan may be opened, a company resolution must be included and the
“Verification of the Existence (Identity) of Corporations or Other Entities” form (FRA1235) must be completed. In addition, Section 5 must be completed.
For the SSQ INV plan, a piece of identification must be submitted to the financial security advisor in compliance with the Proceeds of Crime (Money Laundering)
and Terrorist Financing Act, under sections 83.1 and 83.11 of the Criminal Code. For RIF, LIF, PRRIF and LRIF Plans, this piece of identification is necessary to validate
the age of the person on which the minimum income payments are calculated.
Section 4: Other Parties to the Contract
This section must be completed under the following specific circumstances:
Payer (spousal RSP or RIF): In the case of a spousal RSP or a spousal RIF, this section must obligatorily be completed.
Spouse (RIF/LIF/PRRIF/LRIF): If the SSQ RIF, SSQ LIF, SSQ PRRIF or SSQ LRIF minimum income payment calculation is based on the age of the spouse, this section
must be completed. A copy of the birth certificate of the spouse must be attached. If this section is not completed, the minimum income payment calculation will
be based on the age of the investor.
Co-investor: Where more than one investor exists for a non-registered plan, the name and address of each co-investor and the sharing ratio applicable to each
must be included. In the absence of any other instructions in Section 10, the tax forms will be issued to the investor specified in Section 3. In the absence of any
instructions as to the sharing ratio, the investment will be presumed to be made in equal portions. In addition, any co-investor(s) must sign Section 12.
Legal representative, tutor, curator or trustee: In this section, include the name and contact information of the legal representative, tutor, curator or trustee,
as applicable. The name and contact information of the person presumed incapable of making investment decisions or of the investor who is being represented
must be included under Section 3. A copy of the legal act assigning the power of representation must be attached.
For the SSQ INV plan, a piece of identification for the co-investor or trusteee must be submitted to the financial security advisor in compliance with the Proceeds
of Crime (Money Laundering) and Terrorist Financing Act, under sections 83.1 and 83.11 of the Criminal Code.
Section 5: Annuitant
Under the SSQ Annuity Contract, the annuitant is the physical person (individual) upon whose life the annuity and guarantee relative to segregated funds are
established and upon whose death the death benefit is payable. For SSQ RSP, SSQ LIRA, SSQ RIF, SSQ LIF, SSQ PRRIF or SSQ LRIF plans, the annuitant is the same
person as the investor, therefore it is not necessary to indicate this. In the case of an SSQ INV Plan, complete this section only if the annuitant is not the same
person as the investor, for example in the case where the investor is a legal person (company).
Section 6: Benefit Upon Death of Annuitant
This section need only be completed for “client” type applications, by the investor, or by the investor and the co-investor, should one exist. In the event that the
investor has not designated a beneficiary, the benefit payable upon the death of the annuitant is distributed, where applicable, to the estate of the investor, in
accordance with applicable legislation. Specific provisions are provided for in the contract to determine if the rights conferred under the annuity contract may be
exempt from seizure due to a beneficiary designation, subject to all related applicable legislation.
In Quebec, if the beneficiary designation made by investor does not indicate whether the beneficiary is revocable or irrevocable, then the designation of the
investor’s married spouse or civil-union spouse is irrevocable, while the designation of any other beneficiary is revocable.
However, in the case of an SSQ LIRA, SSQ LIF, SSQ PRRIF or SSQ LRIF additional provisions apply and are described in the SSQ Annuity Contract as well under
applicable pension legislation. With respect to a LIRA, I understand that my spouse is my sole beneficiary regardless of any other beneficiary I have named (unless
my spouse has waived his/her entitlement in writing) and that the consent of my spouse may be required to make a total or partial withdrawal of the funds in
my account.
If the contract is a “nominee” type, the benefit payable upon the death of the annuitant is distributed according to the fiduciary record of the contract held by
the dealer or intermediary.
SSQ assumes no responsibility as to the legality or validity of a beneficiary designation or of a beneficiary change. It also assumes no responsibility relative to
any death benefit payable and paid by a dealer/intermediary.
Section 7: Source of Monies
Indicate the source of monies and attach the appropriate forms, as applicable. For example, the Canada Revenue Agency T2151 form (or equivalent) must be used
for transfers from a DPSP and the T2033 form (or equivalent) must be used for transfers from an RSP or an RIF.
Section 8: Lump-Sum Investments
Select the investment vehicle(s) you want to invest in. For more information about ASTRA Funds, refer to the Information Folder.
Section 9: Automatic Periodic Transaction (APT)
All of the information requested in subsections A, B, C, D, E or F, must be provided, where applicable. In the case of an SSQ RIF, SSQ LIF, SSQ PRRIF or SSQ LRIF
this section must obligatorily be completed. Select the investment vehicle(s) you want to invest in.
For more information about ASTRA Funds and automatic periodic transaction modalities, refer to the Information Folder.
In Subsection C, attach a copy of the birth certificate(s) or, in the absence of such, the financial security advisor must verify the investor’s and the spouse’s date
of birth, if applicable, entering the documents used for such verification in Section 3.
Section 10: Additional Instructions
Be sure to include any additional comments or instructions concerning your application request.
Section 11: Dealer/Advisor
This section must obligatorily be completed. If the contract is a “Nominee/Dealer” or “Nominee/Intermediary” type, the Dealer or Intermediary acting in such
capacity has the right to carry out any transaction relative to the property that he has been mandated to manage by the investor in accordance with the latter’s
instructions at the time of the contract application.
Section 12: Authorizations and Signatures
Read this section and the Declaration carefully before dating and signing the contract application. The financial security advisor, investor and co-investor, where
applicable, must also all date and sign the contract application. If any of these required signatures are missing, the investments may not be made.
In some provinces, the spouse’s consent is necessary for the registration of a locked-in plan. If applicable, the spouse must sign this section or the appropriate
authorization form as indicated on this Application Form.
SSQ Financial Group Investment & Retirement
1) 1245 Chemin Sainte-Foy, Suite 210,
Quebec QC G1S 4P2
2) P.O. Box 10510, Stn Sainte-Foy, Quebec QC G1V 0A3
Tel.: 1-888-391-9299
Fax: 1-866-559-6871
Web site: www.investment.ssq.ca
FRA1292A (2009-05)
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